Hawaii Filipino Chronicle Supplement - September 17, 2022

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Supplement Monkeypox: The Latest Global and Community Health Threat SEPTEMBER 17, 2022 HEALTHLINE: Get a Boost Against COVID: What You Need to Know About BoostersS2 HEALTH NEWS: Free Preparation Guidance for Medicare Open EnrollmentS2 HEALTH NEWS: September is National Suicide Prevention MonthS3 ASK A DOCTOR: Beyond Borders: MonkeypoxS6 ASK A DOCTOR: Out of the Fire, Into the Frying Pan: Long CovidS8 MENTAL HEALTH: The Impact of COVID on Mental Health and Helpful Coping TechniquesS10 MEDICAL REFLECTIONS: Confessions of a Surgeon New MomS11 ASK A DENTIST: Teeth SensitivityS14 HEALTHLINE RESEARCH: UH Reveals Vaccine Hesitancy Factors in Recent StudyS15 WHAT’S INSIDE Still

recovering from the height of COVID-19, com munities around the world are faced with yet anoth er global viral outbreak, this time in the monkeypox. In less than a dozen times ever, the World Health Organi zation (WHO) declared monkeypox a public health emer gency of international concern (PHEIC) on July 23, 2022. The first major cluster of monkeypox cases (outside of Af rica, its origin) was found in the United Kingdom in May 2022. It has since spread to the U.S. in alarming numbers, even to our very own state where already 28 cases have beenForreported.ourcover story in this supplement, find out how to identify the symptoms of monkeypox, who should get the available vaccination at this time, and how to better protect yourself from catching it. In a concurring public health concern, the cover story also gives us an update on COVID-19 in Hawaii and the new bivalent vaccine recent ly made available. Stay informed and stay healthy!

Cover Story on S4 www.thefilipinochronicle.comFollowandlikeuson: www.facebook.com/TheFilipinoChronicle www.twitter.com/HiFilChronicle www.instagram.com/the_filipino_chronicle

Boosters are readily available to all vaccinated people ages 5 years or older. Just like the vaccines, booster shots are available at no cost to anyone living in the U.S. Peo ple who got Pfizer or Moderna vaccines should get a booster five months after the initial doses. Vaccinated adults 18 or older may choose any avail able vaccine as a booster, re gardless of the type or brand of vaccine received previous ly. Only the Pfizer vaccine is available as a booster for those ages 5 to 17.

As of August 10, CDC data showed that while Asian Americans were among the highest boosted group—with nearly 70% of those eligi ble having received their first booster doses—only 14% of fully vaccinated Asian Amer icans 50 years or older have gotten their second booster.

• Pregnant and recently pregnant people


The survey is being conducted by the Hawaii State Department of Health (DOH) and the Centers for Disease Control and Prevention’s Agency for Toxic Substances and Disease Regis try.

who are using the Navy water system can now share their experiences with the State Health Department to further explore the impact of the jet fuel contamination in the US Navy’s Joint Base Pearl Har bor-Hickam drinking water system.

To that end, the We Can Do This COVID-19 Pub

First booster rates are still low for Native Hawaiians and Pa cific Islanders, with less than half of the population age 5 and older receiving their first booster doses.

For more information and to find a vaccine, visit www. vaccines.gov.

“Jet fuel contamination of a drink ing water system on this scale is un precedented,” said DOH State Toxicol ogist Dr. Diana Felton. “This follow-up assessment will further the understand

• People who got a Johnson & Johnson vaccine and

The initial survey conducted in Jan uary and February surveyed over 2,200 participants. The Assessment of Chem ical Exposure health impact survey found that 87% of respondents report ed at least one new or worsening health symptom related to the contaminated water. Eighty percent reported improve ment when they switched to an alternate water source. Moreover, 46% reported new mental health symptoms.

nities through the hurdles of misinformation, fear, mistrust, and entitlement that surround the topic.”Hereis what people should know about the COVID boost ers:

Second boosters provide added protection for people at higher risk. Adults age 50 or older and immunocompro mised individuals can improve their protection even more with a second booster. CDC recommends second boosters, with either the Pfizer or Mod erna vaccines, for:

Individuals who were served by the Navy water system between Novem ber 20, 2021 and March 18, 2022 can access the online survey by heading to pationbedb7b8418ec36.gov/Home/ed35dc5c-389b-4e06-934c-https://epiinfosecurewebsurvey.cdc.TheonlinesurveywillopenthroughSept.23,2022.Particiisvoluntaryandidentitieswillbe

Boosters provide the best protection against severe ill ness and death. Over time, vaccines may become less ef fective at preventing COVID, and just because you’ve had COVID doesn’t mean you can’t get it again. Getting boosted extends your protec tion and keeps you safer from emerging variants. A booster shot is another dose that — as the name suggests — boosts immunity to the virus as time passes. Vaccinated people who have also had a booster are less likely to get sick; but if they do catch the virus, the illness is usually less severe. For adults ages 65 or older, boosters can more than double their protec tion.

their first booster with a Johnson & Johnson dose at least four months ago

• People age 50 or older who got their first booster four months or more ago

DOH Encouraging Navy Water System Users to Participate in Follow-Up Health Impact Survey

ing of how the contamination impacted the health of impacted individuals and inform our public health response.”

• Residents of long-term care settings


Get a Boost Against COVID: What You Need to Know About Boosters

lic Education Campaign has engaged uptakeincreaseorganizationscommunity-basedaspartnerstovaccineandboosteracrossthecountry.Apartnershipbetween

Pacific Island Ethnic Art Mu seum (PIEAM) and Empow ering Pacific Islander Commu nities (EPIC) has humanized the numbers behind those lost to COVID-19 with a curated community exhibit titled, Toe Fo’i: The Return. Through the power of storytelling from 6 Pasifika artists, Toe Fo’i: The Return evokes a narrative that “reminds visitors the stories of those lost are the stories of those who survived,” says Kiki Rivera, PIEAM Guest Curator and EPIC “COVID-19Storyteller.devasted our Native Hawaiians and Pacific Islanders,” says Rivera, “We are as dedicated to drawing awareness to the importance of vaccines and boosters as we are to guiding our commu

kept confidential.

• People with certain under lying medical conditions that impact their immune systems

Vaccines and boosters protect vulnerable popula tions against COVID. Ev eryone 5 or older who has completed their initial COVID vaccination series should get a booster. Individuals who are up to date on COVID vaccines not only receive protection for themselves, but they also help reduce the spread of COVID to people who are at high risk due to age or compromised immune systems.


COVID vaccines and boosters have reduced the threat of COVID, allowing many people to gath er, travel, and celebrate with more peace of mind. Vaccines and boosters provide the best protection against the worst outcomes of COVID, yet peo ple still have many questions around boosters.

The follow-up survey will support the initial survey conducted in January and February of this year. The survey will evaluate the ongoing public health impacts, water usage and attitudes to ward the water system.

Suicide is a significant public health problem in Hawaii. The web site offers resources, events, train ings, task force, data and contact information to provide prevention education to the public.

For more information and re sources about taking action against suicide, visit the Vibrant Emotional Health website to learn more about the #BeThe1To campaign. More over, the American Foundation for Suicide Prevention is also hosting multiple events during National Sui cide Prevention Week.


Hawaii Suicide Prevention Website ry-prevention/suicide-prevention/health.hawaii.gov/emsipsb/inju

he Medicare open enrollment will be starting soon and the Hawaii Executive Office on Aging and the Hawaii State Health Insurance Assistance Program (SHIP) are hosting several events to offer guidance to those turning 65 or those enrolled in Medicare to learn and choose the best Medicare plan to fit their healthcare needs.

Hawaii is hosting multiple 2022 Hawaii Suicide Prevent Month events. See the following schedules: Statewide

Speaker Series Link: eventbrite.comembracinghope2022.UntilNov.7–

The Project Grad 65 presentation informs people turning 65 about Social Security retirement benefits and Medi care basics to guide them with the en rollment period in Medicare. The open enrollment period gives beneficiaries the opportunity to join, switch or drop a Medicare plan with coverage begin ning on January 1, 2023.

“Suicide is a multifaceted issue that impacts all of our communities across the State,” said Gina Kau lukukui, co-chair of the Prevent Suicide Hawai‘i Task Force. “Our comprehensive approach to suicide prevention enhances hope, help, and healing to protect our ‘ohana.”


September is National Suicide Prevention Month

In-person consultations on Oahu

Until Oct. 22 – Embracing Hope

State Executive Office on Aging Offers Free Preparation Guidance for Medicare Open Enrollment

Hawaii offers multiple resourc


The control center provides help for poisoning emergencies.

One-hour counseling – Appoint ments are scheduled on a first- come, first-served basis. To make an ap pointment, call 808-586-7299 or 1-888-875-9229 and visit hawaii ship.org.Oct. 21 and 28, Nov. 10 and 18, 10am-2pm – Consultations will be available at Honpa Hongwanji Ha waii Betsuin located at 1727 Pali Highway, Honolulu

Phone and consultationsZoomstatewide

A Medicare counselor will con tact those who request an appointment within two to five business days.

This 24/7 free and confidential hotline support people in mental health or substance use-related dis tress. The call center staff are locally trained and qualified to provide sup portive counseling and screening for urgent and emergency mental health and substance use needs. They also do referrals to behavioral health re sources.

es to address individuals who are in need of help and guidance. Below are the following:

From 2017 to 2021, over 900 Hawaii residents died from suicide. Suicide is one of the leading causes of preventable death in Hawaii.


Sept 23, 12-1pm – Suicide Pre vention Foundation Course, contact Danielle Bergan, (danielle.bergan@ mentalhealthhawaii.org) and Kris tin Mills (kristin.mills@doh.hawaii. gov)

Nov. 2 and Dec 1, 10am-2pm –More consultations available at the Pearl City Public Library located at 1138 Waimano Home Road, Pearl City

808-586-7299, 1-888-875-9229, hawaiiship.org

Hawaii CARES hicares.hawaii.gov1-800-753-6879,

Kauai Visit PreventSuicideKauai.org for details and updates on all Kauai activities.


The Medicare Annual Open En rollment period begins on Oct. 15 and ends on Dec. 7. Hawaii SHIP will be available for virtual, phone and in-person sessions to assist kupu na. The following are the program’s resources and schedule:

raise awareness this Na tional Suicide Prevention Month, the Hawaii Depart ment of Health and the Prevent Suicide Hawaii Task Force are pro moting available mental health re sources and “Nationalevents.Suicide Prevention Month is an opportunity for the community to come together to raise awareness of this issue,” said Dr. Al vin Bronstein, Emergency Medical Services and Injury Prevention Sys tems Branch Chief.

“Suicide prevention requires outreach and stakeholder collabora tion to ensure resources and support are available to those most in need.”

Link: waii-tickets-404886124297tion-foundation-with-mha-of-haclinic-cfs-presents-suicide-preveneventbrite.com/e/cohen-

Hawaii Poison Control Center hipoisoncenter.org1-800-222-1222,

Well-being & Re silience for Health Professional Link: ets-406407976197well-being-resilience-course-tickclinic-cfs-adventist-health-castle-eventbrite.com/e/cohen-

Sept. 27 – Suicide Prevention Foundations Course

Vibrant Emotional Health and the American Foundation for Suicide Prevention bethe1to.com, nspw.afsp.org

How is monkeypox spread? Prevention

Franciso (last name withheld), 58, Honolulu, said the outbreak of the mon keypox reminds him of when AIDS broke out. “I was living in San Francisco at the time and many of my friends died. I eventually contracted HIV many years later when the HIV-AIDS cocktail drugs came out which have extended the lives of many living with this disease. Right now monkeypox is mostly affecting the gay men population like AIDS used to be. I hope it can be contained before it becomes more widespread.

“While the risk to most Hawaiʻi residents remains low, local transmis sion of monkeypox is occurring,” said Deputy State Epidemiologist Dr. Nathan Tan. “The growing number of cases in Hawaiʻi underscores the importance of vaccination—if you are eligible, please take this step to protect yourself and our community.”DOHcontinues to conduct contact tracing and follow-up with all reported cases.

• People in certain occupational risk group. People at risk for occupa tional exposure to orthopoxviruses include research laboratory work ers performing diagnostic testing for monkeypox virus and mem bers of health care response teams designated by appropriate public health and antiterror authorities.

A rash that can look like pimples or blisters appears on the face, inside the mouth, and on other parts of the body, like the hands, feet, chest, genitals, or

an appointment to get a shot.


Monkeypox Arrives in Hawaii, Update on COVID-19 and Recommendation for New Bivalent Booster Vaccines Quinabo


Who should get vaccinated?

Swollen lymph nodes

“I know many in the LGBT commu nity are upset that the Biden administra tion did not take on the monkeypox vi rus more aggressively in the earlier days. That window of opportunity closed and the virus is already spreading all over,” Francisco said.

Monkeypox is increasingly becom ing known as a sexual contact disease. Health experts say while it could be “sexually transmissible” – sex is only one of the ways that monkeypox can be

This global (outside of Africa) 2022 out break of monkeypox is a first. The first clus ter of cases was found in the United King dom in May 2022 and linked to an individual who traveled to Nigeria. It spread through Europe initially.

he latest emerging infec tious disease outbreak of global importance is mon keypox. The contagious disease has spread to all continents. As of Septem ber 8, there are 56,609 reported cases of monkeypox globally, 21,274 cases in the U.S., according to the CDC.InHawaii, the State of Hawaii De partment of Health (DOH) reports there have been 28 cases as of September 8, with most of them (21) located in Oahu.

Monkeypox has been recognized as an endemic disease in central and west

“Prevention is better than cure. Not only are we protecting ourselves from the possibility of getting infected but also our loved ones and those around us. Prevention is key! It is significant for us to be careful when coming into close contact with those who may have symp toms. If we feel sick, stay home and avoid others for the time being. Proper and frequent hand-hygiene can also play a crucial role in the prevention of mon keypox,” Aquino said.

Anyone in close personal contact with a person with monkeypox can get it. The virus could spread by direct contact of infectious rash, scab or body fluids. It also can be spread by respiratory se cretions during prolonged, face-to-face contact, or during intimate physical con tact, such as kissing, cuddling, or sex.


ChillsRespiratory symptoms (e.g. sore throat, nasal congestion, or cough)

• Gay, bisexual, and other men who have sex with men (MSM) and trans gender individuals who have multi ple or anonymous sex partners (e.g., such as through dating apps)

The virus can also be contracted from materials (like bed sheets or a door knob) contaminated with the virus.

- Muscle aches and backache

What is Monkeypox?

Nikka Aquino APRN-Rx; Aiea, Ha waii, said if the CDC eventually recom mends monkeypox vaccination to the general population, she would schedule

(continue on S5)


- Fever - Headache

On July 23, 2022 the Director-Gen eral of the World Health Organization (WHO) Tedros Adhanom Ghebreyesus declared the outbreak a public health emergency of international concern (PHEIC).

Monkeypox is caused by the mon keypox virus, the same family of virus es as variola virus, the virus that causes smallpox. Monkeypox are rarely fatal, but rash that typically accompany mon keypox can be painful and people can experience severe outcomes, health ex perts say.

Symptoms of monkeypox

At the moment, the CDC does not recommend widespread vaccination against monkeypox. But the monkey pox situation is being monitored and evolving quickly and could be subject to change.DOH says vaccine supplies are cur rently limited. DOH’s current eligibility taken from their website are as follows: Hawaii residents ages 18 years and older and fall into one of the following •categories:Hadclose contact in the last 14 days with a person with known or suspected monkeypox infection

Symptoms of monkeypox can in clude any or all of the following:

anus. The rash goes through different stages before healing completely. Sometimes, people get a rash first, followed by other symptoms. Others only experience a rash.

• People who are severely immuno compromised (e.g., advanced or poorly controlled HIV infection [CD4 ≤200 cells/mm3, persistent HIV viral load >200 copies/mL, or a recent HIV-related illness], active cancer treatment, high-dose ste roids) or have certain skin condi tions, such as eczema, and who have a household member or sex partner at high risk for monkeypox

ern Africa since 1970. In an average year, a few thousand cases occur in Af rica. But cases outside Africa have pre viously been limited to only a handful of cases, until now.

Monkeypox will typically last 2-4 weeks -- at which time the infected person is contagious – and would require usually home recovery with minimum contact. While most who have been infected re cover on their own in their homes, some have been hospitalized.

James Pagdilao, Hilo Hawaii, also said he would get the monkeypox vac cination if recommended by the CDC. “I would definitely get vaccinated as a duty to not only myself, but to the rest of the publicHepopulation.”said,“monkeypox is to be taken seriously, as contrary to popular belief, it can be spread through other means than the typical contact. Monkeypox, like any oth er infectious disease, should be treated like any other infectious disease that requires a Quarantine/Isolation period and careful precautions to avoid further spread.”

spread. Experts emphasize that any close, sustained skin-to-skin contact (even non-sexually) with someone who has monkeypox can spread the virus.


Because of the similarities between smallpox and monkeypox, antiviral drugs used to treat smallpox is being used to treat monkeypox infections.

Preventative steps include: 1) avoid ing close contact with someone infected with monkeypox as well as touching the objects and materials the person has used; 2) Wash your hands often with soap and water or use an alcohol-based hand sani tizer, especially before eating or touching your face and after you use the bathroom; 3) postpone having new casual sex part ners and avoid events where you have close bodily contact with others

-Waianae Coast Comprehensive Health Center (in Waianae and Kapolei) at 808-427-0442

It’s recommended that if you be lieve you’ve contracted monkeypox, to contact your personal physician. Treat ment for monkeypox is available but must be coordinated through DOH and a physician.

COVID-19 UPDATE in Hawaii

The DOH recommends the use of the first bivalent booster vaccines designed specifically to protect against original

The U.S. Food and Drug Adminis tration issued Emergency Use Authori zation for the bivalent COVID-19 boost ers late last month.

The Hawaii Department of Health has ordered about 38,000 doses of the bivalent Covid-19 booster. The new vaccine is administered by Pfizer and Moderna. The bivalent Covid-19 boost er could start arriving this month.

Completed vaccination is 77.3% statewide with Honolulu having the highest at Aquino,80%.who did catch COVID-19 in February 2022, said “I think people should still acknowledge that COVID is still around. Although vaccines and medications are available for us to help prevent the debilitating compli cations, we can still contract the virus if we are not mindful of it. Each one should be responsible in taking his or her part in controlling the spread of the virus through proper hand hy giene, avoiding extremely crowded areas, and wearing masks or avoiding contact when sick.”

-Hawaiʻi Health & Harm Reduction Center (in Honolulu) at 808-521-2437

Pagdilao who caught COVID-19 in May this year, said “I just hope and pray that we can keep up to date with boosters and obtaining the so-called herd immunity.”

– Dr. NathaN taN, Deputy State of Hawaii epiDemiologiSt

Limited appointments are also available through DOH by calling our monkeypox hotline at 808-586-4462 or requesting an appointment online.

(Monkey Pox Arrives....from S4)

“As opposed to early on in the Pan demic, the majority of the population is vaccinated, resulting in less hospital izations and less severe infections, so overall COVID is generally like the flu in which we should get updated boosters when available to keep not only ourselves protected, but to protect the rest of our vulnerable populations such as the elder ly, those with significant comorbidities, and our keiki,” Pagdilao said.

Oahu resident options:

COVID-19 and the most common forms of COVID-19 in Hawai‘i, the BA.4 and BA.5 Omicron subvariants.

“While the risk to most Hawaiʻi residents remains low, local transmission of monkeypox is occurring. The growing number of cases in Hawaiʻi under scores the importance of vaccination—if you are el igible, please take this step to protect yourself and our community.”

The new bivalent vaccines are to be administered as a single booster dose to those who previously completed a pri mary series of COVID-19 vaccines and those who have had one or two boost er doses. Bivalent boosters can only be administered if it has been at least two months since a person’s most recent vac cination.Aquino


Monkeypox Vaccine Clinics in Hawaii

Kauai residents can contact Malama Pono Health Services (in Lihue) at 808246-9577 and the Kauai District Health Office by calling 808-241-3495

Char said the new booster is avail able for people 12 years and older. The vaccine is expected to be available for people 12 years and older, which would cover a wider range of the state’s popula tion than the second Covid booster that’s only available for people older than 50 years and immunocompromised.

-Kaiser Permanente, Mapunapuna Medical Office (in Honolulu) at 808432-2000 and prompt #1 (for members and non-members)

COVID-19 is still very much active and around

were reported, bringing the statewide cumulative death toll to 1,655.

The U.S. government has two stockpiled vaccines—JYNNEOS and ACAM2000—that can prevent monkey pox in people who are exposed to the virus.

The DOH Summary Metrics as of Sept. 7, 2022 reports there have been 1,215 news cases of COVID-19 state wide in the last week. Eleven new deaths

Maui residents can contact Malama I Ke Ola Health Center (in Wailuku) at 808-871-7772Hawai’iIsland residents can contact Hamakua-Kohala Health (in Honoka’a) at 808-930-2751Forothersites, call DOH’s monkey pox hotline at 808-586-4462

The BA.5 subvariant accounts for an estimated 91% of the COVID-19 cas es in Hawai‘i. The BA.4 subvariant ac counts for an additional 4% of the cases in Hawai‘i.“TheCOVID-19 boosters we have been using do a good job of protecting us against severe illness. The new bivalent boosters are an upgrade because they take into account mutations of the COVID-19 virus to specifically address Omicron subvariants,” said State Health Director Dr. Elizabeth Char, FACEP.


received her booster shot in September 2021. “I plan to get the fourth shot. The bivalent vaccine targets both the original strains of SARS-CoV2 and the subvariants of Omicron BA.4 and BA.5.“COVID-19 is here to stay. For more than 2 years, people have faced the eco nomic consequences of the pandemic. But is the pandemic ‘over’? I think when we say that the pandemic is over, it does not mean that the virus has been eradicated rather the horrific stage of intense transmission and consequent illness is better controlled. With the constant changes in strains, per sons can still get the virus. Some may say that COVID-19 is now similar to just a regular seasonal flu. However, I think that because of the long COVID complication of post-illness, we must all continue to be careful not to spread or catch the virus,” AquinoPagdilao,said. who says he is moderate ly immunocompromised, said he got the 4th Bivalent Booster shot. “COVID-19

today is still just as serious of an issue than it first started, but due to vaccina tions, social distancing, and new studies on the spread of COVID-19, it has be come a part of daily life to live with the normalcy of COVID infections.

The DOH ordered its full allocation of the JYNNEOS vaccine from the fed eral JYNNEOSgovernment.is FDA-approved for safe and effective monkeypox prevention in adults. JYNNEOS reduces one’s chanc es of getting monkeypox and may reduce symptoms after becoming infected.

The new booster not only protects from severe illness and hospitalization, but also help to minimize even getting infected or getting reinfected.


ed person can happen to help limit the spread.

and scratches, handling animal products such as skin or fur, or consuming undercooked meat of the infected animals.

seniors in Hawaii who rely on Medicare, and lowering prescription drug costs in Medicare and enabling us to negotiate these costs is something that so many of us who were here, when the Afford able Care Act was first enacted, some thing that we have been pushing for, for over 10 years. It took that long for us to enact this right to negotiate, something that the VA—which is the largest health care system in our country—has been doing for decades. One thing that is going to make a difference to so many seniors right now is that those seniors under Medicare will be able to get their vaccinations free. One out of three older Americans will be affected by shingles and a lot of them don’t get the vaccine because they had to pay for it—no lon ger,” said Hirono.

who have sex with men. Indi viduals who have multiple or anonymous sex partners are also at high Vaccinesrisk.are available to help prevent infection and can be given after closeavoidingwashing,tionstactCOVID-19CDCDepartmentthroughulinscomplications,mised,ease,thosemostlytoitingMonkeypoxexposure.isaself-limdiseasebutcanlasttwofourweeks.TreatmentissymptomaticbutforwhohaveseveredisareimmunocomproorareathighriskforimmunogloborantiviralsobtainedconsultationwiththeofHealthandcanbegiven.Measuresusedforfocusonconandrespiratoryprecausuchasfrequenthandwearingmasks,andgatheringswherecontactwithaninfect


The disease appears sim ilar to Varicella, or chicken pox, so it must be differen tiated from chickenpox in order to help curb the spread. Infected individuals can be infectious starting from the onset of symptoms until the rash disappears and new skin forms which will typically last between 2-4 weeks.

a press conference, Senator Ma zie Hirono shared the new provi sions in the Inflation Reduction Act (IRA) of 2022 that will make health care more affordable for people across the country.TheIRA will empower Medicare to negotiate drug prices for 10 medi cines in 2026, which will gradually in crease to 60 by 2029. Medicare’s direct negotiation with Pharma is expected to lower the price of drugs. Another IRA provision caps out-of-pocket drug costs for Medicare enrollees at $2,000 per year.Moreover, Sen. Hirono sponsored a provision in IRA to ensure Medicare recipients will receive all necessary vaccinations at no cost.

“There are about close to 300,000


Inflation Reduction Act’s Health Care Savings

Monkeypox is highly in fectious, and we are in the midst of an outbreak.Asof the end of August, there are a total of 23 monkeypox cases in Hawaii. Na tionally, many of the cases from the outbreak have been among men


Human transmission is most commonly caused by direct skin-to-skin contact with a monkeypox lesion or through contact with bodily fluids of an infected person. It can also spread through contact with fomites (fabric, sheets, towels, etc.) that have been in contact with the le sion, and it can also spread through a cough or sneeze from an infectious person.

An infected person usual ly develops symptoms within three weeks of exposure to the virus. The symptoms include flu-like symptoms, exhaus

Clean and disinfect fre quently touched surfaces and do not share items with others.

Beyond MonkeypoxBorders:

The rash may be locat ed on or near the hands, feet, chest, face, and genitalia. The rash will initially look like sores or pimples and transform into blisters. The lesions can be painful and/or itchy and go through several stages includ ing scabs falling off before a fresh layer of skin will appear.

tion, swollen lymph nodes, and rash. After the onset of flu-like symptoms, a rash ap pears between 1-4 days later.

By Avery Go, MD

If you think you have been exposed or are infected, isolate and call your health care provider immediately. Those around or who share a common living space with an infected person should take care not to get in contact with the skin lesions or any materi al that may have come in con tact with the skin lesions.

The first human case was reported in 1970 in the Demo cratic Republic of Congo and for decades it was a disease considered endemic in Cen tral and West Africa.

An infected person should also avoid taking care of pets while sick, as they might spread the virus to the animal who then might spread it to otherInpeople.themidst of anoth er threat, remember to stay vigilant, stay safe and stay healthy!


almost three years, COVID-19 has had an enormous effect on the world. Lockdowns, social distancing and masks became the new normal. Just when we thought life was starting to return to the normal that we knew, monkeypox appears.

Monkeypox is a zoonotic (disease transmitted from ani mals to humans) viral disease caused by the monkeypox vi rus that belongs to the Poxvir idaeThefamily.origin is unknown, but it was discovered in the 1950s in monkeys kept for research. Infected mammals such as prairie dogs, mon keys, hedgehogs, squirrels and dogs can transmit the vi rus toTransmissionhumans. from infected animals happened through bites

DR. ZIA KHAN is a cardiologist and Hawaii Division Board Pres ident for the American Heart As sociation.

vessel that feeds the brain gets blocked, usually from a bloodWhenclot.the blood supply to a part of the brain is cut off, some brain cells will begin to die. This can result in the loss of functions controlled by that part of the brain, such as walking or talking.

Most people survive their first heart attack and re turn to their normal lives, enjoying many more years of productive activity. But experiencing a heart attack does mean that you need to make some changes.Themedications and life style changes that your doc tor recommends may vary according to how badly your heart was damaged, and to what degree of heart disease caused the heart attack.

Whether young or old, living a healthy lifestyle is key to preventing your risk of having a heart attack or stroke. The American Heart Asso ciation recently updated its lifestyle recommendations to include eight key actions you should follow. It calls those actions Life’s Essential 8. Go to the Association’s web site at healthy-living/healthy-lifehttps://www.heart.org/en/styletolearnhowyoucanlivehealthierandavoidheartattackandstroke.

or young people, or those who’ve never known someone who’s had a heart attack or stroke, there can be a misperception that heart attack and stroke aren’t related. But they can be, and both are largely pre ventable if you live a healthy lifestyle.Heart and blood vessel disease (also called heart disease) includes numerous problems, many of which are related to a process called ath erosclerosis, a condition that develops when a substance called plaque builds up in the walls of the arteries. This buildup narrows the arteries, making it harder for blood to flow through. If a blood clot forms, it can block the blood flow. This can cause a heart attack or stroke.

Heart Attack vs Stroke

The good news is that sometimes brain cells don’t die during stroke — instead, the damage is temporary. Over time, as injured cells repair themselves, previously impaired function improves. (In other cases, undamaged brain cells nearby may take over for the areas of the brain that were injured.)

within the brain bursts. This is most often caused by uncon trolled hypertension (high blood pres sure).

blood clot. If this clot cuts off the blood flow completely, the part of the heart muscle supplied by that artery begins to die.

A heart attack occurs when the blood flow to a part of the heart is blocked by a


Some effects of stroke are per manent if too many brain cells die after being starved of ox ygen. These cells are never replaced.

A hemorrhagic stroke occurs when a blood vessel

By Zia Khan, MD

what stroke rehabilitation is all about.When it comes to recog nizing a heart attack or stroke and getting help, the faster, the better. That’s because prompt treatment may make the difference between life and death — or the differ ence between a full recovery and long-term disability.

Either way, strength may return, speech may get better and memory may improve. This recovery process is


An ischemic stroke (the most common type of stroke) occurs when a blood

sequelae of SARS-CoV-2 infec tion (PASC).”

By Dennis Bautista, MD

“Broad range of symptoms (physical and mental) and symp tom clusters that develop during or after COVID-19, continue for more than two months, have an impact on the patient’s life, and are not explained by an alterna tive diagnosis.”

What is Long COVID?

What are the symptoms of Long COVID?

These vaccines have been proven to help prevent COVID infection and hospitalizations. Remember, patients who were hospitalized for COVID were more likely to get long COVID.

the last three years, COVID-19 has contin ued to spread among our community, resulting in more than 330,000 cases and 1,641 deaths in the State of Hawaii. According to the Hawaii De partment of Health (DOH), there are still an average of about 200+ new cases daily, but the actual number could be much greater because a lot of cases are not reported to the DOH.The combined efforts of the global community has resulted in new policies, infrastructure, and therapeutics that have re duced the severity and deaths from COVID infection.


The work continues

As mentioned above, Long COVID patients can suffer from a variety of physical and mental issues.The most common per sistent physical symptoms in clude: Fatigue, Shortness of breath, Chest pain, and Cough.

Less common symptoms

include lack of smell, joint pains, nasal congestion, taste abnormalities, poor appetite, dizziness, muscle pain, insom nia, hoarseness, hair loss, and diarrhea. Psychological or cog nitive symptoms include new or worsened problems with memory, concentration, anxiety, depression, and post-traumatic symptoms.Thesesymptoms often lead to a patient’s disability, keeping them from going back to work, or even doing their activities of daily living.

But a new, and mysterious health problem has emerged: Long COVID. It has also been referred to by several other names, including “postCOVID conditions,” “chronic COVID-19”, and “postacute

Out of the Fire, Into the Frying Pan: Long Covid

Most patients who have mild illness are expected to have res olution of symptoms over a few weeks, even without interven tion. Most patients get better.

At this time, the most ef fective prevention is not getting a COVID infection in the first place. This means continuing to take precautions like social distancing and masking when

For those who continue to have symptoms, a primary care doctor can help do further inves tigation, and make sure that they are not dealing with an alterna tive condition. A primary care doctor can also help alleviate the patient’s symptoms by optimiz ing a patient’s medical therapy.

Researchers and clinicians continue to study COVID and its long-term effects on patients. In time, there would hopefully be more information on the exact mechanisms behind this condi tion which may in turn lead to finding more effective treatment.

While waiting for all these, we hope the members of the community continue to protect themselves and each other, and to continue to work with their doctors and the local health au thorities.

How long do these symptoms last?

What can we do for patients who have Long COVID?

appropriate..Thereis also no over-stress ing the importance of COVID vaccinations. There will be a new version of the vaccines (“bivalent booster”) that has been approved by the FDA, and these are aimed at the more cur rent COVID variants.

So far there has been no widely accepted definition, but Centers for Disease Control and Prevention, as well as the World Health Organization, describe Long COVID as:

The length of time patients continue to suffer from these symptoms greatly vary, from just a couple of weeks to sev eral months. That being said, there seems to be a tendency for patients who are unvaccinated, older, had more severe disease, and had multiple co-morbid ities to have a more prolonged course.

What can be done to prevent Long COVID?

At times, there may be a need for the patient to go to a specialized center. Here in Hawaii, the Queen’s Medical Center has a “Post COVID Re covery and Care Clinic,” which requires a referral from a PCP.



You feel bad about your self, feeling like you are a failure or let your family down. You are sleeping more or less than the recommended hours. You have lost interest/ motivation in daily activities including those that you en joyed in the past.

Signs That You Need Help

You are often worried about many things. You are afraid of leaving home or go ing out into public or being around lots of people. You

The following coping techniques may help you.

Here is a simple tech nique: find a comfortable sitting position, inhale slow ly through your nose for 4-6 seconds, feeling your stom ach rise as you feel your chest fill with fresh air. Hold for 5 seconds and slowly ex hale through your mouth with your lips pursed (like you are kissing someone), and feel your stomach fall as the air is being released. Another vari ation is to skip holding your breath for 5 seconds. Practice as often as possible.

healthy coping techniques include journ aling, light stretching, light exercise, healthy eating, call ing a friend, helping others, watching a funny or inspiring movie, cleaning your house, car, or yard, gardening, and keeping yourself busy and staying on a routine schedule.

By Jay Valdez, Psy.D.

praying, and being part of a church fellowship.


experience panic attacks and shortness of breath, feeling sad, hopeless and helpless.

thoughts of hurting yourself and/or ending your life.


2. Calm your body by doing proper breathing exercis es. Breathing exercises tell the brain to relax the body. Proper breathing exercises start with dia phragmatic breathing or stomach breathing.

You feel numb or not car ing about the consequences. You are eating more and/or bingeing on junk foods. You are drinking more alcohol and using more drugs.

3. Make a list of things you


A national survey indi cated that anxiety and de pression went up 41%. An other survey showed that rates of reported anxiety and depression went up from 1 in 10 people to 4 in 10 during COVID. Additionally, the rate of substance abuse, do mestic violence, and suicid ality has also increased.

the start of the COVID pandemic, there has been a signif icant increase in people feel ing anxious, depressed, iso lated, hopeless, and uncertain about the future.

1. Calm your mind by med itating such as playing relaxation music, using a relaxation app, watch ing relaxation videos on Youtube, listening to a podcast, listening to a book, reading a book, doing a walking medi tation, going to church,

The Impact of COVID on Mental Health and Helpful Coping Techniques

You are having difficulty concentrating and focusing. You feel more irritable or quick to anger and have more arguments with your spouse or loved ones. You are hav ing mood fluctuations and

can be grateful for. Our minds have the tendency to remember and hold on to negative events. A gra tuity list helps our mind balance our negative thoughts with positive ones. It may also help us look at our lives from a more realistic perspec

If you are still struggling, please call your doctor. If you are in crisis, call CARES Ha waii at 808 832-3100, Crisis Text Line at text MHA to 741741, Crisis Helpline at 808 832-3100/800 753-6879 or 911.

Although advances in reproduc tive technology have resulted in suc cessful pregnancies for many, I did not get pregnant after a significant amount of time and money invested in this emotionalAfterward,rollercoaster.Igavemyself time to reset and try to get back to my normal busy schedule. To our delightful sur prise, we were blessed with a natural pregnancy several months later.

There are more AMA pregnancies in countries with higher availability of socioeconomic resources. The deci sion for family life is also patient-de pendent; if a patient embraces the idea of having a large family, then she may start having children early in life well into AMA.

In Hawaii, it is also location and race distribution dependent. Culture plays a role in the acceptance of early versus late childbearing.

Miscarriages are most often due to chromosomal genetic abnormalities, which increase with age.

I was under the care of MFM and


Dr. Corrie Miller is an MFM spe cialist in Honolulu and takes care of high-risk pregnancies. Her practice is about 40% AMA.

But because it’s such a personal and traumatic topic of conversation, it is not always talked about freely.

Confessions of a Surgeon New Mom

My ObGyn (Obstetrics-Gynecol ogy) colleagues state the miscarriage

During this leg of my journey, I thought I was alone and one of the few AMA women, but as I learned more and spoke to more people, miscarriages and the use of reproductive medicine is more common than we might think.

(continue on S12)

For instance, ObGyn Dr. Lisa Nat avio shares that in her previous practice in Wahiawa, with a high population of Filipinos and Polynesian-mix patients, there were less AMA first pregnancy mothers compared to her current Ewa Beach practice, where there is a more variable patient population (ie Hawaii locals, military, new Hawaii residents from mainland, etc).

I am very grateful to my husband, professional colleagues, and family who really stepped up to be there for me. I safely delivered my beautiful son on November 10, 2021, via cesar

AMA is defined as having a preg nancy when a woman is over 35 years old.

I was excited and scared, but more scared to be honest. I was very grateful for the blessing, but as a medical pro vider, had some knowledge about the risks of having a child as an advanced maternal age (AMA) mother-to-be.

Reproductive medicine is a boom ing specialty of gynecology.

I was one of those who sadly un derwent the pain of loss with a mis carriage. I was subsequently referred to a reproductive specialist given the challenge of age and time. I also felt guilt and shame since I thought that I did something wrong.

rate at 35 years old is approximately 15-20%. At 40 years old, it is between 30-40%, and at 45 years old it ap proaches 50-80%.

By Marel Ver, MD

I married “late” at 38 years old. Then, I embarked on a new challeng ing journey –having my first child at the age of 40.

Care involves many appointments, different types of invasive and non-in vasive testing, hormonal medications, and even costly reproductive proce dures involving patient and partner.

MFM specialists do not just take care of AMA patients, but also those women with higher risks due to med ical problems like diabetes, hyperten sion, and obesity.

Genetic testing may provide a path to decision-making. Some chromo somal abnormalities are incompatible with life. Others can produce a viable baby but possibly with birth defects.

My genetics testing was nega tive, but I was monitored closely for placenta previa (placenta blocking the delivery canal). I tried to be as healthy as I could during my pregnan cy within the limits of my busy life as a working surgeon.

She shares that anecdotally Ha waii has a lower incidence of AMA pregnancies compared to her previous hospital in Connecticut where there is a significant percentage of highly edu cated white women.

Common treatments include intra uterine inseminations (IUI) and in vi tro fertilization (IVF). Egg and sperm donation and freezing, and surrogacy may also be discussed.

Being pregnant over this age in creases the risk of complications like miscarriage, congenital disorders, and overall maternal health risks like high blood pressure and others. Further more, as age increases, infertility also rises. Referrals to fertility and repro ductive specialists have increased sig nificantly over the last few years.

AMA patients are often sent to a Maternal Fetal Medicine (MFM) specialist to discuss genetics testing

and risks, complications, and prenatal management.

ObGyn colleagues who provided ex cellent personalized guidance and man agement during my pregnancy journey.

However, the majority of older patients already have some idea of the risks and expectations of pregnan cy. Therefore, maintaining a healthy pre-pregnancy lifestyle is even more important.

MFM specialists help guide pa tients when difficult decisions may need to be considered. The ObGyn guidelines recommend referral to a specialist after three miscarriages. Many ObGyns start referring at two miscarriages especially since emo tions, time, and age are factors.

took many years of schooling and training to achieve success in my current career as a general surgeon. Additionally, many years of re al-life community experience have helped me excel as past President of the Philippine Medical Association (PMAH), as well as attain other lead ership positions at my hospital.

Fortunately, I am healthy with out baseline medical issues. My col leagues share that in AMA, the amount of prenatal visits is not necessarily in creased but does so depending on risks and complications found. They also share that prenatal counseling is not significantly different in younger and older pregnant patients.

My ObGyn colleagues share with me that the percentage of AMA patients can be demographically dependent.

Dr. Marel Ver with son, Kobe


In Ewa Beach, her rate of AMA first moms is about one in five patients compared to her patient population in Wahiawa.

The concept of my husband or I staying home was considered, but re ally not feasible in practice given the existing shortage of specialists in both of our fields. Moreover, we help to fi nancially support our parents through our work.I’mstill struggling with the idea that work should stay at work. While at home, my energies are to be mom and I’mwife.working on being less stub born to improve my partnership with my husband as new parents which can be difficult. My husband is probably experiencing similar feelings being an older new Insteaddad.of reading about new sur gery robots, hernia meshes, and the latest operative techniques, I am now researching strollers, child-proofing devices, and school tuitions.


With more women in medicine and law, leadership positions, and tradi tionally male-dominated fields, moth erhood for the working professional is

grateful to my parents, who are also deemed ‘older’ Lola and Lolo, for helping to care for their first apo given their physical limits.

For new mom care, mental health screening and monitoring for post partum blues and depression are very important.TheCDC

Lastly, if you are a young wom an who is considering a longer career path, or you are a parent with a daugh ter who wants to go further, please know that it’s okay. The “biological clock” does exist, but “there is no per fect time to get pregnant” is often said in late path individuals.

I would like to thank and acknowl edge my PMAH colleagues, especially Lisa Natavio, MD (ObGyn) and Corrie Miller, DO (MFM) who contributed their expertise to this article.

that there are waiting lists for daycares and schools. It is not easy to find vetted caregivers.

reports about 1 in 8 moms experiences postpartum depression. In terestingly they also report that 1 in 10 new fathers report depressive symptoms.

(Confessions....from S11)

I am fortunate to have the person al support of various friends and col leagues to help me do so. But even more importantly, I have the unwaver ing support and love of my own par ents to guide me in this journey.

I try not to think about the ex pectant challenges of being that older parent when my child graduates high school and transitions into adulthood.

My workdays start later and end earlier so I can pick up my baby son from childcare. Of note, we were lucky to get into daycare, as it was news to us

The ‘work-life balance’ is an on going challenge.

My reality is now the challenge of taking care of my new baby in addition to taking care of our aging parents.

The concept of “mom brain” is real. The tired mom is a whole new different type of tired.

It is not easy to find an old-school yaya in the United States. I do not live in a multigenerational home.

I chose to push towards my poten tial which delayed motherhood and ac cepted the risks and unmeasurable joy that comes with it. Until society com pletely acknowledges, accepts, and adjusts to the journey of motherhood, professional women will often find themselves at a crossroads.

Again, to my surprise, my patients celebrated my pregnancy with me, and were happy that I was actually “taking time for me”,” because I’ve done so much for Perhapsthem.”it’s just my luck having such nice patients or the fact that in Hawaii, the concept of family is so highly regarded.


As a mentor to a handful of young Filipinos, this pressure is very real. I have students who struggle with the notion of supporting their families as soon as possible versus following their dreams. Perhaps this sentiment con tributes to the scarcity of Filipinos with advanced academic degrees and a de creased presence in higher leadership and executive positions.

Know that you are not alone. Know that all of your dreams, even of motherhood, can be possible. And it’s all worth it.

Being the senior and the leader in my office, I felt somewhat embar rassed asking my younger counterparts for mom advice and hacks.

MAREL VER, MD is a general surgeon in West Oahu and recent past president of PMAH.

As I am back at work again, ramp ing up to almost pre-pregnancy pro ductivity, I am forced to adjust my schedule and be more efficient, as it’s not just about me anymore.

I had to cut down drastically on my workload pre and post-pregnancy. I had to make physical adjustments to safely work in the operating room.

I was always encouraged by my parents to further my career path, with a focus on long-term financial stability. Therefore, starting a family early was not a priority for me.

It is not uncommon now that women start family life late when their careers, relationships, and finances are more stable. There are also older women who are still single or those in repeat marriages or relationships. This is in contrast to the general Filipino culture that pushes you to settle with a good job and have a family early.

I did not train in a generation where motherhood was graciously welcomed in medicine, especially within the sur gical field. Therefore, the amount of joy and support for me from my col leagues was refreshing.

ean Beingsection.at the top of my game in my medical field is a stark difference from my life as a rookie new mom, where I often feel lost and sometimes helpless. I didn’t grow up taking care of babies or kids, therefore taking care of my own newborn was a brand new “skill set” I had to learn.

slowly gaining wider acceptance and is more celebrated, compared to the past. There are ongoing movements for gender equality in many fields in this country and others.

is a gift, but only a woman can bring life into the world. Like my dedication to being the best surgeon leader I can be, I’m going to be the best mom I can possibly be.

This article is a personal one to me and may strike a chord with many. I do wholeheartedly believe that we are all born with potential, in a life that is a series of choices.

Personally, all my AMA first baby colleagues have since shared that they felt this very same way. At the end of the day, I finally gave in and stubborn ly accepted the help that was offered, especially because I really need it for my own health and sanity.

Despite advice from many sea soned moms, articles, books, and phone apps, nothing gets you ready for the real thing until the real deal.

My ObGyn colleagues share that their screening does not differ be tween young and older patients. How ever, they do acknowledge that older patients may have a different set of stressors and challenges as compared to youngerDespiteones.mycandidly honest think ing and perspectives about mother hood, when my son smiles back at me with a face that mirrors mine, it is all worth it. My life has indeed changed. So, this is what parenthood is.

I honestly felt guilty about not be ing able to service my patients or del egating their care to another provider. Many of my patients have been under my care for years.

I try not to compare myself to my younger counterparts who seem to physically and mentally bounce back so quickly.Iamvery


The rites of passage and the joy of a little person made from both of you


The habit of eating hard candy, ice, grinding your teeth or getting hit in the mouth can chip or crack teeth. A small crack in the tooth may not be problem

taking a sip of hot coffee make you wince in pain, or eating ice cream give you a painful chill? You’re not alone. The Academy of Gen eral Dentistry says 40 million adults in the United States experience tooth sensitivi ty. These are a few common causes for tooth sensitivity.

Dr. Steven Rhee of Ha waiian Eye Center shares, “An increase in screen-time and decreased time spent outdoors may harm children’s vision and can put them at higher risk of developing myopia, or near sightedness. This condition can sometimes lead to even more serious eye conditions in their“Increasedadulthood.”screen-time and a lack of natural light and time spent outdoors can be harmful to our children’s vision and eye health. These circumstanc es can put our keiki at a higher risk of developing myopia, or nearsightedness. My biggest concern is that these kinds of conditions can sometimes fol low them into adulthood and worsen,” he explained.

We offer a wide range of services and would be happy to help you deal with your tooth sensitivity or any other oral health concern. I will do my utmost to make your vis it a pleasant and comfortable experience.

• Keep digital media 18 to 24 inches away from the face

by plaque and tartar build up on your teeth, which can make your gums recede.

Although nearsightedness can be corrected by glasses or contact lenses, it can still lead to several eye problems later on such as retinal detachment, glaucoma and macular degen eration.The best way to try and stop this from happening to your children’s eyes is to take the proper preventative mea sures and ongoing eyecare as their eyes and vision continue to develop.“Iknow there is this ste reotype of children today hav ing a short attention span or difficulty concentrating, but I think we forget that there is also a number of new factors at play that may be contributing to this.” Dr. Rhee closes.

“It may be a sign that your child is having vision problems and needs you to help them get the right support. We should be reminding them to take breaks, spend time outside, properly lubricate their eyes by blinking regularly.”

With summer ending and a new school year beginning, comes an increase in comput er and screen usage, as well as new germ exposures and transmissible variants in our classrooms. Both of which can have serious consequences on our children’s eyes and vision.

By Michael Dang, DDS

• Acidic Diet

la. Some people can form a hypersensitivity to the whit ening chemicals over a peri od of time.

atic at first but if left un checked can be very painful.

• Hard Impact

Some studies suggest that spending time outdoors may slow the onset and progression of nearsightedness. The gener al consensus within the scien tific community is that spend ing time outdoors balances out close-up work and helps main tain strong and healthy eyes in children.TheWorld Health Organi zation recommends that chil dren under 5 spend one hour or less per day on digital devices, and children under one year old spend no time on digital devices.The Children’s Eye Foun dation recommends daily out door play, no screen time for those under age 2, a maximum of one to two hours per day for kids ages 2 to 5 and guid

ing pain. Brushing too hard can also cause the gum to recede, that will lead to pain and sensitivity.

If you’re having tooth sensitivity and wonder what this means to your oral health, give our dental office a call at (808) 596-2568.


Parents can help protect and preserve their children’s eye health and vision by man aging their children’s screen time to support educational use while limiting cartoons and video games. Parents can also encourage more outdoor activities by creating a sched ule, setting limits on screen time, and planning ahead for outdoorOtheractivities.recommendations to protect and preserve your chil dren’s eye health are:

• Set a timer to remind kids to take those breaks

Teeth Sensitivity Protect Your Child’s Eyes and Vision!

there is still a crucial need to monitor and maintain our chil dren’s eye Withinhealth.theclassroom, this can be done by resting their eyes, intentionally blinking, and looking at things further away to prevent discomfort.

The rise of digital learning has marked an increase of chil dren experiencing dry eye and eye strain due to prolonged screen time, while full capac ity classrooms can become hotspots for colds, viruses, and germs that may cause eye inju ries or infections.

Most of the time the prob lem can be resolved from a simple change in behavior, or something as simple as changing your toothpaste. In the case of recurrent decay or a crack tooth a new filling can fix the problem, but it should be taken care of early before the problem worsens.

Though many schools are returning to in-person teach ing after the nation mandated COVID-19 lockdowns, there are still risks for nearsighted ness along with other vision concerns to look out for.

the retina instead of on top of it, creating a blurry image in the field of vision.


Over a period of time fillings can wear down and break around the margins. These tiny crevices trap bacteria which causes acid buildup and enamel break down.

This can make it extreme ly difficult for children to learn and excel in school and may cause eye pain or headaches.

• Whitening Toothpaste

While doctors and scien tists are still learning exactly how myopia develops and pro gresses, we do know that it can occur when the eye’s focusing power is too strong, causing light rays to focus in front of

ed screen time with frequent breaks for kids over 5.

Citric acids from orang es, lemons, limes, grape fruits, kiwis break down the enamel as well. I tell my patients not to add slices of fruits to their water. While drinking water often is a good thing, having citric ac ids constantly on your teeth is not because it damages the teeth and causes sensitivity.

• Encourage 20-second breaks from closeup work every 20 minutes

By Janet Kelley

• Gum Disease

• Brushing Too Aggressively

In support of raising awareness to these issues, The American Academy of Oph thalmology has named Au gust “Children’s Eye Health & Safety Month.”

Even with non-digital learning tools such as books or other things, it is estimated that roughly 80% of classroom learning is visual. That means

• Make sure they are getting a full and well rested sleep

Many toothpaste manu facturers add tooth whiten ing chemicals to their formu

full of vitamins A, C, and E

It is particularly important for children to spend at least a couple hours a day in natural light and have some time away from digital screens in order to protect their eyes.

Brushing too hard may wear down the protective layers of enamel and root cementum and expose mi croscopic tubules. These tubules lead to the dental nerve and can cause a shock

• Introduce nutritious and balanced meals and snacks

• Protect their eyes outside with proper eyewear


• Recurrent Decay

Gum disease is caused

Thyroid hormones play a vital role in maintaining the body’s metabolic rate. The

Some patients may devel op an enlargement of their thy roid gland or “goiter” due to these hormonal disturbances.

centers to act on the devel opment of effective strate gies that include vaccination to help us emerge out of this pandemic.”Aside from Juarez, Maunakea and Okihiro, oth er co-authors include UHE RO graduate research assis tant Zheng Khang, JABSOM computational biologist Krit Phankitnirundorn and WC CHC community facilitator Blane K. Garcia. To read the full text of the research paper, head to com/2076-393X/10/9/1435.https://www.mdpi.

As mentioned, hyper- and hypothyroidism affect the pro duction of thyroid hormones. Apart from these, some pa tients develop distinct lesions or lumps in the thyroid itself referred to as “thyroid nod ules.”

also plays a role as in the case of iodine deficiency. Iodine is vital and a key factor in thyroid hor mone production. Its scarcity in diet amongst certain coun tries contributes to a global health problem, with millions of people suffering from hy pothyroidism worldwide.

As an endocrinologist, I often get asked by non-medical folks what kind of diseases I see in my practice. Endocrinology is a field in medicine that deals with the diagnosis and treat ment of hormonal disorders, which can cause a myriad of problems and symptoms, and therefore negatively impact one’s overall health. These hormonal imbalances require careful and meticulous workup so that we can address the problem accordingly and re store the body’s homeostatic functioning.Thethyroid gland is a but terfly-shaped organ normally situated in the lower portion of the anterior neck which se cretes thyroid hormones. Thy roid hormones travel through the blood stream and affect different tissues in the body.


UH Reveals Vaccine Hesitancy Factors In Recent Study

Thyroid diseases are com mon and can be distressing. However, most of the dis ease entities are manageable if proper care and actions are taken in a timely fashion.

By Anna Melissa Lo, MD

Autoimmune conditions such as “Graves’ disease” and “Hashimoto’s thyroiditis” are immune-mediated processes that lead to hyperthyroidism and hypothyroidism, respec tively.Nutrition

Thyroid Health & Hormones

There are a variety of entities that can cause either hyper- or hypothyroidism in patients.

anxiety, tremors, difficulty of breathing, sleeping distur bances, irregular menstrua tion, and eye problems.

Most of these thyroid nod ules are harmless, but some can increase thyroid hormone production or even turn out to be cancerous. Therefore,

On the opposite end, some patients end up having less than normal production of thyroid hormones, “hy pothyroidism,” which slows down metabolism causing significant weight gain, pro found weakness and fatigue, forgetfulness, dry hair and skin, and cold intolerance.


the booster shot, compared to only 30.5% of those who waited three to six months. The latter group also ex pressed that they gained trust and consumption of of ficial information after four months.“This study shows that social factors, including ed ucation and individual-lev el degree of trust in sources of COVID-19 information, played a large part in wheth er someone decided to get a booster shot,” said Ruben Juarez, one of the authors of the study and an econom ics professor at UHM and HMSA Endowed Profes sor of Health Economics at UHM’s Economic Research Organization.Fellowauthor and as sociate professor at UH’s

Co-author May Okihiro, JABSOM associate profes sor and WCCHC pediatri cian, says: “This date pro vides critical information for the Department of Health and our community of health

Women are five to eight times more commonly affect ed than men. Undiagnosed thyroid disease can cause not only significant symptoms, but also long-term health complications, such as car diovascular disease, impaired bone health, and even mental issues.Ifyou feel you are having any issues with your thyroid, ask your primary care physi cian about it, and if necessary, seek a hormone specialist.

thyroid gland gets its signal from the brain, particularly from the master hormon al gland called the pituitary gland, and from another high er center in the brain, called the increasedalsymptomsbody’sroidism,”roidsecretion.ulationtionsaffected.whentained.monesnormalcohesiveitary-thyroidhypothalamus.Thehypothalamus-pituaxisworksasaunittoensurethatarangeofthyroidhorissecretedandmainProblemscanariseanypartofthisaxisisThereareseveralcondithatcancausedysregofthyroidhormoneExcessproductionofthyhormones,“hyperthycanspeedupthemetabolismcausinglikeunintentionweightloss,palpitations,nervousnessand

clinically significant bumps in the neck should be thor oughlyThyroidevaluated.disorders are quite common and affect an estimated 20 million Ameri cans in the United States, ac cording to the American Thy roid Association.

University of Ha waii at Manoa (UHM) and Waianae Coast Comprehensive Health Cen ter (WCCHC) partnered in a research paper to learn more about vaccine hesitancy fac tors in PublishedHawaii. on August 31 in MDPI’s journal titled Vaccines, the paper is titled “Dynamics of Trust and Consumption of COVID-19 Information Implicate a Mechanism for COVID-19 Vaccine and Booster Up take.”UH researches surveyed almost 1,6000 Hawaii adults enrolled in COVID-19 test ing program. Participants completed standardized surveys from January to February 2021. They an swered questions regarding

demographics, vaccination status and trust in sources of COVID-19 information during the COVID-19 delta variant wave. Then during the omicron variant wave, 50.3% of those respondents complete ed a follow-up sur vey from January to Febru ary Results2022. of the study show that participants vac cinated within two months of eligibility tended to have more years of schooling and greater trust in and con sumption of official sources of COVID-19 information, compared to those who waited three to six months or more to get vaccinated post-eligibility.Seventy percent of those vaccinated within two months of eligibility took

John A. Burns School of Medicine (JABSOM) Alika Maunakea said: “Results from our study reinforces the need to nurture trust and promote health literacy in our community, which our model predicts will improve vaccine uptake, including boosters.”


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